Question

1. A 30-year-old pregnant Thai woman was referred to a hematologist because of anemia. The hematologist ordered an H & H with RBC indices, iron studies and a urinalysis. The iron studies and urinalysis were within normal limits. The H & H is below.

	Patient result	Reference range
Hemoglobin	8.1 g/dl
HCT	27%
MCV	65 fL	80-100 fl
MCH	20 pg
MCHC	30%	32-36%

What is the most common cause of anemia in pregnant women? Is it causing this patient’s anemia? _

A hemoglobin electrophoresis was ordered and demonstrated an abnormal band suggestive of Hb H. _

What is the etiology of her anemia? _

Answer 1

Most of the women during pregnancy have anemia.

ANEMIA

IRON is the main element required to produce adequate amount of HEMOGLOBIN.

Hemoglobin is a protein pigment present in RBCs which help in supplying oxygen from lungs to all parts of the body.

When body doesn't have enough iron to produce adequate amount of hemoglobin, it causes IRON DEFICIENCY ANEMIA in which blood cannot carry enough oxygen through out the body.

This woman has anemia because she has anemia lower then 10g/dl

The Normal range of hemoglobin in women ranges from 12 to 15.5 g/dl.

It is considered normal anemia if a woman has her hemoglobin in the range of 10 to 10.5 g/dl. Lower then that is considered as anemia.

CAUSES

Hemoglobin (hb) H is a form of alpha thalassemia in which anemia develops due to reduced formation of alpha globulin chains.

This patient has a history of anemia and therefore she is at higher risk of anemia.

During pregnancy body produces more blood for the growth and development of the foetus.

Lack of nutrients in diet can cause reduction in iron and other essential nutrients.

SYMTOMS

Pale skin ( due to reduced blood )

Dizziness ( due to less supply of oxygen to body and brain)

Feeling of tiredness ( difficulty in supplying enough oxygen)

ETIOLOGY

The microcystic hypochromic (MCHC) anemia is due to impaired hemoglobin production due to decrease in alpha chain which causes thalassemia.

During pregnancy she has high chances of having a blood transfusion due to a high reduction in the hemoglobin reading.